Jeffersontown, KY · Jefferson County
Affidavit of Assurances
This affidavit records an applicant’s assurances that contractors and subcontractors on a permitted project will comply with Kentucky workers’ compensation and unemployment insurance requirements.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The City of Jeffersontown Department of Permitting and Enforcement form identifies the permit location and project, then asks the applicant to assure that all contractors and subcontractors employed on the project will comply with the stated insurance requirements. The applicant completes it for the referenced project and signs before a notary. The form does not specify a submission deadline.
Who needs it
An applicant for a referenced project in Jeffersontown completes this form to provide the city with assurances about contractors’ and subcontractors’ insurance compliance.
Why it needs a notary
The form has an acknowledgment and sworn statement before a notary; the applicant named in the affidavit signs before the notary and completes the notary’s commission details.
How to get this notarized
- 1
Download the Affidavit
Get the Affidavit of Assurances from the City of Jeffersontown.
- 2
Fill In the Project Details
Enter the permit location and project description, then print the applicant’s name.
- 3
Book an Online Notary
Schedule a session with a commissioned online notary and have the unsigned form ready.
- 4
Sign on Video
Sign the affidavit in front of the notary during your online session.
- 5
Submit to the City
Follow the City of Jeffersontown Department of Permitting and Enforcement’s instructions to submit the completed form.
Preview the form
The blank PDF straight from Jeffersontown. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the Affidavit of Assurances?
- Enter the permit location and project description, print the applicant’s name, and sign before a notary. The form asks you to assure that contractors and subcontractors will meet the stated insurance requirements.
- Do I need to sign this affidavit in front of a notary?
- Yes. The form includes an acknowledgment and sworn statement before a notary. Wait to sign until you are with the notary, who completes the notarial section.
- Can I use an online notary for this form?
- Kentucky authorizes its notaries to perform online notarizations when registered as an online notary public. A commissioned online notary can explain whether the notarial certificate they provide fits this form.
- Where do I submit the completed affidavit?
- The form is issued by the City of Jeffersontown Department of Permitting and Enforcement. Check with the department about how to submit it for your project; confirm with the city or county clerk if unsure.
Affidavit of Assurances in other Kentucky cities
Each city publishes its own version of this form. Pick the city where you’re filing.